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Friday, February 20, 2015

From the Archives: HIV's Achilles Heel

HIV/AIDS Updates: Achilles Heel

[Article originally published in Out IN Jersey Magazine]

AIDS is not an immediate death sentence anymore, but rather a manageable disease. In the same time, while the number of AIDS-related deaths is decreasing, HIV infections are on the rise—the most recent CDC statistics show that 56,000 (not 40,000) Americans become infected every year. While today’s HIV/AIDS patients and their physicians can choose from a variety of powerful medications to keep the disease in check, some AIDS experts believe that treatments do not pave the way to a world without AIDS; a cure does.

The Road Ahead. Photo by Alina Oswald. All Rights Reserved.

While some may believe that an AIDS cure is still out of sight, a group of AIDS experts led by Doctor Sudhur Paul of the University of Texas Medical School of Houston announced that the possibility of discovering an AIDS cure might come sooner than envisioned. The statement is based on the discovery of the HIV’s weak spot, otherwise referred to as “HIV’s Achilles heel.” This discovery would lead to destroy, entirely, the virus in the human body.

From the early AZT mono-therapies to today’s HAART regimens, the medications have had the ability to keep the virus in check, but not to entirely destroy it. That is because HIV has the ability to constantly mutate and adapt to medications by changing its coating. HIV infects the human body by attaching itself to an immune system cell called the T-cell (or CD4 helper cell). Doctor Sudhir Paul and his colleague, Doctor Miguel Escobar, have discovered a section of HIV—a key protein the virus uses to attach itself to the T-cell—that does not mutate. HIV has to keep this key protein constant in order to attach itself to the immune system cells.

Doctor Paul and his team discovered a way to attack this protein, using a catalytic antibody (antibody with enzymatic activity) called abzyme, which is created naturally by the body and found in people with lupus. When scientists applied abzyme to HIV, the virus was permanently destroyed. This makes the new way of fighting HIV drastically different from the ones known so far. Eventually, this novel procedure could destroy all the HIV in the human body and, in time, lead to an AIDS cure.

Until then there is much work still to be done. Doctor’s Paul procedure has worked so far in lab tests and animal trials. Next phase is human trials for which HIV patients may have to wait for five years. Usually, in creating a new medication or vaccine, problems start with the clinical trials, partly because clinical trials are very costly and partly because that’s where most vaccine trials have had problems in the past.

Recently, several vaccine trials have failed while India has reported a successful completion of phase two of a potential AIDS vaccine. While Doctor Paul believes that an AIDS vaccine may be available some ten years from now, let’s not forget that it took scientists 42 years to develop a vaccine for whooping cough, 47 years for a polio vaccine and 105 years for a typhoid fever vaccine. How long would it really take to an AIDS cure?

A singer and songwriter, an actor, a screenwriter and director, an advocate for LGBTQ youth, Anthony Lovari is a man of many talents. As an actor, the artist has appeared in movies like The New York Strangler (about a NYC Halloween party terrorized by a supernatural force) and, with a small role, in Sydney Pollack’s The Interpreter (2005). Recently, Lovari has begun screenwriting, producing, directing and acting in his own movie, which is inspired by true events of a series of shark attacks in NY waters and scheduled to be released in early summer, 2008. Shore Thing brings together a diverse and talented cast, including actors like Jade Estevan Estrada (or how NBC News calls him, “America’s Prince of Pride), among other well-recognized names.

Although he loves acting and directing, Lovari is maybe best known for his music. “I’ve always loved music,” he confesses. “I started singing at [the age of] five.” Being introduced to music at such a young age and being inspired and encouraged by both his parents to pursue his talent, it’s no surprise that Lovari decided to study music therapy at Queensborough College in Queens, NY, where he was born. Music therapy, the artist explains, is a medical (psychology) field that uses music to sooth or to create a sense of stability, particularly in the elderly and in people with mental disorders.

And soothing is exactly what Lovari’s music and voice do for his audience. When it comes to music, Lovari’s influences are as many as they are diverse and include artists like Annie Lennox, Tony Braxton, The Eagles, to mention only a few. Like many other songs, Lovari’s are mostly about love. Yet what makes them unique is the reality of love they evoke—from lost love and betrayal to un-returned love and the idea of finding true love. “It’s instinctual to write about love,” the artist says, explaining that his music is inspired by Freud and even more by Jung who believed that the mind thinks of love.

But Lovari’s music conveys not only the reality of love, also the reality of life in all its aspects. An avid reader, the artist has always enjoyed reading books by authors writing about reality. In time, the topic started to reflect in his songs. Therefore, his music speaks to all of us, bringing out in the open our own realities and allowing us to reconsider our life choices and goals.

These Tears also represents the artist’s stand on love and its non-idyllically reality, thus reflecting the side of him that makes his advocacy work possible. “When it comes to love,” the artist-advocate says, “people have to have respect for themselves. It is not cool to have sex just because everybody else has [sex].” He encourages everybody, especially the youth, to practice safer sex, have monogamous relationships or be single rather than have unprotected sex. Too many people, especially young people, today don’t follow the model of playing it safe and thus they put themselves at a greater risk of getting HIV or any other STD. Lovari talks about HIV/AIDS as being part of the larger STDs content, mentioning that among the male especially gay population ages 18 to 24, the number of STD infections has increased by 150 percent!

What is Lovari doing about it? He does youth advocacy work through Jersey’s LGBTQ youth organization, Our Youth, founded by Rob De Anthony. Lovari was part of A Night of Awards ceremony in May as a presenter and performer.

When it comes to his fans that are also his friends, Lovari considers himself blessed to have so many of them. “I’m very grateful for everybody who’s listening to my music,” the artist says. “This is my dream. I hope to accomplish a lot in my life.”

She is the first openly transgender correspondent to appear on a national TV show—Under the Pink Carpet, an LGBT news and entertainment show. She has performed on stage and on screen, in large and small production films. She has her own gossip column—Gossip Girl—and curated art shows like Strike A Pose - Gender Id in 2008, hosted by SoHo’s Leslie-Lohman gallery. She is Lady Clover Honey, a fixture in New York City social and entertainment life and in the city’s annual Gay Pride Parade.

“I think I was born with a feminine spirit,” Lady Clover Honey (a.k.a. Clover Welsh) describes herself. “I have a man’s body, which is fine with me, and I have a female spirit, so that I can express myself sometimes as a man and sometimes as a woman.”

Lady Clover Honey. Photo by Alina Oswald. All Rights Reserved.

Born in Totowa, New Jersey, Lady Clover Honey recalls always being different growing up. “I don’t know what it’s like to be normal,” she comments. As a kid, she never fit in. Other kids used to call her names, but she didn’t care because she was mature enough not to care. She has always been out, never in the closet. She’s also been lucky to have parents who accepted her the way she was.

Right after graduating from college, Clover moved to New York City where she started writing poetry and became involved in a neo-pagan movement that accepted those living on the fringes of normal, and also accepted women as divinity. That’s how Clover discovered the Radical Faeries, a spiritual movement started by Harry Hay in 1979. While most of the members of this spiritual movement are usually gay and feminine, they vary from one region of the country to another. Clover joined the Radical Faeries community in Brooklyn, where she lived at the time. She describes them as wearing beautiful blouses and broaches, not necessarily dressing as women, but starting to create the image of a woman, reaching for God (or Goddess) and the spirit.

Lady Clover Honey at the Gay Expo 2014, in New York City. Photo by Alina Oswald. All Rights Reserved.

“It’s always been my fantasy to be a beautiful woman, like Marilyn Monroe,” Lady Clover Honey confesses. A decade ago, when she started being a drag queen, she got her first wig on sale on 14th street. “I thought anybody can be a blonde or a brunette, but I’d rather be a purple, actually more of a maroon.” When three photographers for the Radical Faeries wanted to take her picture, she was happy to model—the photo appeared in Time Out NY. Today Clover is on the Board of Directors for Fresh Fruit Festival. She believes that drag queens are interesting, and that gender expression makes such a visual art that she decided to put together a show for them in Strike A Pose, celebrating gender identification in our contemporary society.

Recently, Clover had a small, yet poignant role in Lovari’s directorial debut, Shore Thing, a film taking a fresh look at possible shark attacks in the New York waters. In Shore Thing, Clover plays a librarian—a woman usually not perceived as good looking. And, with the fine artistry we are used to, by now, Lady Clover Honey shows that all women, even librarians, can be glamorous. As with everything else she does, Lady Clover Honey uses her Shore Thing character to continue breaking taboos.

Today, drag queens are still on the fringe of what society considers “normal.” Drag queens are also different images of God. “I think God is a force,” Clover explains. “It’s important to have a spiritual connection to the universe. It helps us to be strong. [I] hope that the universe, God (or Goddess), loves me as well.”

Lady Clover Honey cherishes her connection with the universe, and also wants to do her part and help others here, on earth. Therefore, she reaches out to the person who is afraid to go out dressed as a woman because people would throw stuff at him. She reaches out to all individuals and encourages them to be who they truly are, to come out of the closets of their lives. While she is very aware that coming out is not always easy or safe, she hopes that “We all have to respect one another, because we’re all children of God, with different ways to express ourselves.”

She’s always been an optimist, especially when it comes to gay rights, when she believes that we make progress every year. “I do have hope,” Lady Clover Honey concludes. “We’ve come a long way in 40 years. We have a long way more to go.”

A safe place to start, especially for those living with HIV/AIDS, is to call Frank Musumici, Investigator with the Office of Civil Rights of the U.S. Department of Health and Human Services. A Hoboken native, Musumici has worked with the local HIV community for many years. Before joining the OCR team in 2004, he was a regional health administrator. His job enabled him to get to know the local HIV community while giving presentations to help provide funding for several small HIV organizations. It was during one of these presentations that the enthusiasm and passion with which he talked to the audience caught the attention of Michael Carter, OCR Regional Manager for Region 2 (representing New York, New Jersey, Puerto Rico and Virgin Islands). Soon afterwards, Musumici became part of the OCR team.

The OCR enforces the laws that prohibit discrimination against race, disability, color, age, religion, national origin and sex. It protects individuals from discrimination in health and social services programs (from hospitals and Medicaid/Medicare to nursing homes and nutrition programs) that receive money or assistance from the DHHS. Although the OCR deals with denied or delayed services because of disability (HIV is considered disability) many people call in with various types of complaints. In this case, the calls are redirected to investigators who can best be of help. The OCR investigators work with complaints that are less than 180 days old. Musumici focuses on HIV-related issues, but the department deals with a variety of issues, from quality of services (which are redirected to the Department of Health) and immigration, to translations. Most OCR investigators are attorneys. Many of them are bi- or multi-lingual, which comes in handy when dealing with individuals who know little or no English. Investigators call these cases LEP, or Limited English Prevalence, cases.

Musumici encourages people to call if they need help, regardless of the type of their complaint. To make sure of that, he provides his phone number-a direct line-because he wants people to know that if they have questions they have someone on their side, an agent whose job is to assist them and protect their rights. That's why, upon his becoming an OCR investigator, Musumici helped start an outreach plan that enables investigators to go out and inform the community about the services HHS/OCR provides. "I'd like to put a physical face to our agency," he explains, "so that [individuals who need OCR's help] will know that they can come to us."

Individuals can contact HHS/OCR by phone, in writing or online. The website provides a complaint form which can be completed and mailed in. The complaint form requires basic information about the complaint: what, when, where and how it happened and why does the applicant think it happened. Once the OCR department receives it, the complaint goes to the department managers from where it is assigned to one of the investigators. Within 30 days from receiving the complaint form, OCR investigators follow-up for more information regarding the incident. In the same time, the facilities where the incident took place are directly interested in solving the problem because they receive funds from the DHHS. "In my experience," Musumici says, "ten out of ten times when we call, [the facilities] are very responsive. They do everything possible to make sure that [the incident] doesn't happen again."

Through his outreach program, Musumici emphasizes the importance of knowing the "ABCs" of civil rights. "If [individuals] know that they have somewhere to go in terms of discussing an act of discrimination against them, I think it empowers them to be strong and go on. We need people to know that [the information they provide] helps investigators help others." When someone contacts an OCR investigator with a complaint, that individual enables the investigator to follow through. As a result, the hospital where the complaint originates takes all possible measures to sustain and solve the problem so that it will never happen again. The process empowers that someone to assist many others who will be going into that hospital. "I want people to know," Musumici concludes, "that this is a great opportunity to empower themselves to do good."

Friday, January 30, 2015

In June 1981 Los Angeles doctors found a strange type of pneumonia, called Pneumocystis carinii pneumonia, in five young gay men. PCP is a type of pneumonia caused by a microorganism that occurs naturally in the lungs of people and animals. Although the medical professionals knew that PCP was associated with a weakened immune system, the cause of this impaired immunity was a mystery. The patients died within days. That same summer, a New York Times article announced the appearance of a rapidly fatal form of a rare cancer that doctors had found in 41homosexual men. A CBS newscaster also reported that this mysterious cancer seemed to be spreading only in the gay community. In 1985, the Center of Disease Control announced that it wasn’t a “gay cancer” after all causing all the disease and death, but rather a virus called Human Immunodeficiency Virus, or HIV. The CDC also called the multitude of strange diseases the virus caused Acquired Immune Deficiency Syndrome, or AIDS. It wasn’t until the disease claimed the life of a Hollywood celebrity that the threat of the virus was brought home to many Americans.

Ripples. Photo by Alina Oswald. All Rights Reserved.

Fast forward to 2008. Researchers at the University of California, San Francisco, called attention to a multi-drug resistant staph infection, called MRSA, prevalent among men who have sex with men (MSM). The epicenter of this infection seemed to be San Francisco’s Castro district, and also Boston. Not long afterwards, reports started to surface, alarming individuals that the multi-drug infection, also referred to as “the newest gay plague,” could take over the general population.

Reaction to the super-infection news is two-fold. Those who’ve lived through the early years of AIDS consider some media treatment of “the newest gay plague” news a “deja-vue” of the eighties. Those who’ve always considered AIDS a plague sent by God to punish sinners, use the “newest gay plague” news the same way they used the “gay cancer” and AIDS news to fuel homophobia and anti-gay hate crimes, to alarm and misinform individuals, thus, potentially, to put them at risk of getting infected with MRSA.

So, is MRSA a deadly threat? And why should we be aware of it, if at all?

MRSA (pronounced MER-SUH), or Methicillin-resistant Staphylococcus aureus (staph for short) is an infection caused by bacteria present on the human body, for example, on the skin and in the nose also armpit, groin or genital area. Initially present only in hospitals and nursing homes, a strain of MRSA has extended to the general population. This new strain, called CA-MRSA, or Community-Associated MRSA, appears mainly in gyms. Depending on the type of sport they practice, athletes can get infected from rubbing against the gym equipment that, in turn, can cause broken skin on the hands, knees, elbows, buttocks or sides of their legs.

MRSA is easily spread through skin-to-skin contact, be that skin contact with people who are infected (including sexual contact) or touching contaminated surfaces. MRSA can appear as sores, blisters filled with fluid (called impetigo when they appear on the face), red painful bumps under the skin called boils or abscesses, or as cuts that become swollen and filled with pus. Some 25-50 percent Americans have staph in their nose, but they are unaware of it. In healthy individuals, MRSA infection may cause pimples. In individuals with a compromised or weakened immune system (such as those with HIV/AIDS) staph can cause deep skin infections, pneumonia, blood or joint infections.

Although MRSA is resistant to most of the antibiotics usually used to treat this kind of infection, doctors have not run out of options to treat this kind of staph infection. Experts make it clear that MRSA is not an “AIDS all over again” plague, it’s not a gay plague, but rather it can happen to anybody who comes in contact with the bacteria.

Practicing common sense when coming in contact with infected surfaces makes a huge difference in preventing infection. Experts advise taking a shower with soap and water. Unscented soaps like Ivory and Dove are less likely to cause skin allergies. Fact is—soap and water can kill 99.9 percent of the staph.

Monday, January 26, 2015

Finally, finally, winter is finally here. And the first blizzard or the year, too. That's right. It's called winter storm Juno.

So, I had to check it out, if only for a few moments. I got my camera ready, placed it in the waterproof special plastic bag, to keep it from getting wet, dressed warmly, and did not forget my special photographer gloves, the ones that allow you to pull out your thumb and index finger in order to be able to use the camera. One word of caution, here. Do not pull our your fingertips before it's the right time, because they will freeze and become numb, and you won't be able to use them to...operate the camera. In addition, keep in mind that the camera is in a plastic bag, which makes it even more difficult to photograph.

Did I mention that I've been battling a nasty cold for a few days now, and that today, before my contact with the snow, I wasn't feeling too bad, but I can't say the same thing now, that I'm back inside? But it's all for a very good reason.

Anyway, when I stepped outside, it was, well, it was cold, and windy. The wind started picking up by the time I reached the waterfront. Two joggers passed by me, only to do it again, only a few moments later, in the opposite direction.

As I reached the boardwalk, I realized why the two joggers had changed their minds so quickly--snow, frozen snow, and, mostly, wind, the kind that slashes and slaps the skin. I walked around only for a few moments, enough to take a couple of snapshots of an invisible Manhattan, and ferry silhouettes, resembling the ghost ship from Pirates of the Caribbean.

NYC Ferry on the Hudson during winter storm Juno. January 26, 2015. Photo by Alina Oswald. All Rights Reserved.

I walked a few more steps, squinting, only to notice a shadow of a skyline, and also city lights. It was the city line of Lower Manhattan. From outside the island, when you cannot see Manhattan, it feels like you're in the middle of nowhere. Lost in space and darkness. It's the weirdest feeling, uneasy and somewhat unpleasant....

Lower Manhattan buildings as seen from across the Hudson River, during winter storm Juno, January 26, 2015. Photo by Alina Oswald. All Rights Reserved.

Needless to say, I didn't hang out for too long. On my way back home, I noticed tiny snow tornadoes forming from the ground up, in the air. They wouldn't last long, only as long as the wind was gusting through them.

And in all that storm, there were a few people, finding their way home. Maybe they were coming from grocery shopping, a bag in their hands.

A woman stops for a few moments, facing the snow, carrying a bag with groceries. Behind her, an invisible Manhattan Island. Photo by Alina Oswald. All Rights Reserved.

What I found most fascinating was the patterns created by the snowflakes in the wind, illuminated by garden lights. They would changed direction flawlessly, slicing the air, zigzagging as they were about to weave it an icy coat

Friday, January 23, 2015

AIDS turned twenty-eight this year! Sometimes it’s hard to believe that it all started with one genetic transformation from a monkey virus to a human one, with (possibly) a hunter in the jungles of Central Africa sometime in the late 1930s. That one mutation led to the first HIV infection, which medical professionals officially recorded in 1959. The infected hunter, the world’s AIDS patient zero, left his village for the large cities of Africa and the opportunities they provided. The crowds and busy city nightlife attracted both the hunter and his virus in different ways. Soon, HIV started to spread from person to person, taking over communities, cities, countries and continents, becoming what we know today as the global AIDS pandemic.

Missing Link. Photo by Alina Oswald. All Rights Reserved.

While most HIV/AIDS experts agree today that HIV, the Human Immunodeficiency Virus, has mutated from SIV, or Simian Immunodeficiency Virus, scientists have also been interested to find out why SIV doesn’t destroy its hosts, while HIV has decimated those it infected?

This year AIDS experts may be closer to an answer thanks to a nine-year research study on chimpanzees at the Gombe National Park in Tanzania. The study results show that chimps are the only other primates, besides humans, that are not immune to the immunodeficiency virus. The virus in question is a new strain of SIV, one that is as deadly to chimpanzees as HIV is to humans.

The discovery is significant because it connects the strain of non-deadly SIV in monkeys and apes to the deadly strains of HIV that have killed tens of millions of people. Researchers call it “the missing link” in the history of the AIDS pandemic.

There are a few similarities between the deadly strain of SIV and HIV: chimps and humans have contracted the respected viruses in similar ways—by eating contaminated monkey meat; both species have spread the viruses in similar ways—through sexual encounters. Experts believe that the other primates have remained healthy despite contracting SIV because, in time, they have adapted to the virus. Chimpanzees started getting infected with SIV only recently; therefore, they did not have enough time to adapt to the virus.

There is the school of thought suggesting that, in time, HIV itself becomes weaker. Past years studies have shown that the HIV of the early eighties was more damaging than the HIV of today. Another aspect that needs to be considered is the HIV/AIDS treatment (HAART medications) available today, treatment that was almost non-existent in the early days of the pandemic.

Experts hope that studying the new strain of SIV will help them learn more about HIV. While this brings new hope to those in the continuous fight against the AIDS pandemic, the newly discovered strain of SIV represents an immediate death sentence for the chimps that are already placed on the list of endangered species because of diseases, hunting and loss of habitat. Unlike humans, chimpanzees don’t have the necessary (anti-SIV) medications to keep them alive. For them, the clock is ticking…

The eyes may be windows to the soul, but the mouth is an open door to a person's overall health. Rigorous oral maintenance and regular checkups can play a vital role in one's oral--and overall--health. This is of special significance to HIV/AIDS patients whose already weakened immune systems make them more prone to infections.

Many health issues start in the mouth. For HIV/AIDS patients, issues like decaying teeth, dry mouth, cavities or mouth sores may signal the existence of more serious health problems. For example, dry mouth can be related to certain HAART [Highly Active Anti-Retroviral Therapy] regimens, while untreated or late detected cavities can be hosting infections that later on may spread throughout the entire body, causing significant damage; mouth sores or lesions, if cancerous, can be manifestations of HIV/AIDS-related cancers.

While a lot of information is available on a wide range of HIV/AIDS medical topics--HAART regimens, for example--information on HIV/AIDS-related oral care and oral conditions is not as abundant or easily available. In addition to the general dental problems, HIV/AIDS patients should be in particular aware of a series of issues that can affect their oral health, be that because of their compromised immune systems, HIV itself or side-effects to their medications.

Studies have shown that the cases of oral lesions and periodontal disease in people living with HIV/AIDS have significantly decreased after the advent of HAART regimens. This is because the new medications have improved patients' immune systems beyond the levels triggering certain infections, including certain oral conditions. In the same time, the new medications, especially a certain class called protease inhibitors (PIs), may be the cause of an increased number of oral warts in HIV/AIDS patients.

A 2004 study conducted by the U.S. Department of Health and Human Services has shown that eighty percent of people living with HIV/AIDS will develop at least one oral condition during the course of the disease. Over thirty oral conditions have been reported in HIV/AIDS patients since the beginning of the epidemic. Most frequent conditions include oral candidiasis (thrush), oral hairy leukoplakia (OHL), HIV-related cancers like [oral] Kaposi's sarcoma (KS) and lymphoma, also HIV-related gingivitis and periodontitis that affect the gums and teeth, xerostomia (dry mouth), caries and human papillomavirus (HPV).

Among these conditions, thrush is maybe the most common and one of the earliest signs of the disease. Thrush and/or OHL are conditions that should prompt individuals to take an HIV test. Also, HPV and xerostomia (and related issues) are most frequently met, today, in HIV/AIDS patients.

Candidiasis, or thrush, is a fungal infection occurring when the T cell count falls below 400 (measured per unit of blood). Although thrush is the most common in people living with HIV/AIDS and one of the earliest signs of the disease, it can also be caused by dry mouth, extended periods of stress, depression or use of antibiotics. The infection usually occurs inside the mouth but it can also extend to the throat and corners of the lips. When painful, thrush can cause loss of appetite, loss or distortion of taste, and discomfort. Treatment includes antifungal medication administered in the entire body (systemic) if the infection is extended, or as local application (topical).

Oral hairy leukoplakia (OHL) is a viral infection and one of the most common oral conditions found in people living with HIV/AIDS. Believed to be caused by Epstein-Barr virus--that causes mononucleosis (mono, a.k.a. kissing disease), OHL appears as white patches with a hair-like appearance (hence the name) on the walls of the mouth or on the sides of the tongue. OHL occurs when the T cell count is very low, thus it's less probable in patients who are on HAART regimens. Treatment includes ganciclovir (a medication also used to treat CMV, or cytomegalovirus, that can attack the retina and the digestive system, including the oral cavity). Also, propolis tincture (from bees) has proven to be a helpful alternative therapy.

Nowadays, human papillomavirus (HPV)--that usually causes genital and anal warts--is more common in HIV/AIDS patients. HIV makes the HPV lesions more serious and more difficult to treat. HPV lesions can occur on the skin and in the mouth. Although lesions can be removed surgically or with laser, they can also reoccur. Infection with HPV, including infections with (HPV-16) type of HPV, can increase the risk of cervical and anal cancer. In the mouth, it can increase the risk of oral (mouth or throat) cancer. Prevention includes safe oral sexual practices.

Another very common oral condition found in HIV/AIDS patients is dry mouth, or xerostomia. One cause can be the virus itself--HIV can cause salivary disease, which can lead to swollen salivary glands and, therefore, a reduced amount of saliva in the mouth. Another cause can be the antiretroviral medications--especially certain classes of HAART regimens, for example protease inhibitors (PIs) like indinavir (Crixivan) and nucleoside analog transcriptase inhibitor (NRTI or nuke) like ddI (didanosine, Videx). Antihistamines, antihypertensives, antipsychotics and antidepressants can also cause dry mouth. Other factors include allergies and infections.

Why saliva is important? And why a dry mouth can be a serious health problem?

A dry mouth may enable food particles to remain in the mouth and build up between the teeth and the gum, thus causing tooth decay, periodontal disease, and candidiasis. A dry mouth can also cause high acid levels to persist in the mouth after eating, thus allowing the appearance of cavities, which, in turn, can further lead to infections that can spread throughout the entire body.

In HIV/AIDS patients, cavities develop at the cervical region of the tooth, that is where the crown meets the root of the tooth and where the surface consists of cementum (not enamel). Cementum is a bony substance with a faster decaying speed. The process can lead to infections of the tooth pulp (the soft tissue inside the tooth) and abscesses (infections, pus). Oral care is vital in discovering these kinds of issues in early stages. Treatment includes a technique called "scoop and fill." Using hand instruments and usually no anesthetic, dentists scoop out the damaged part of the tooth and fill it in with a temporary fluoride-based filling that prevents further decay. For abscesses, treatment options include antibiotics, in particular penicillin.

Bacterial infections are a result of overgrowth bacteria. In HIV/AIDS patients, bacterial infections that occur in the mouth signal the virus' presence in the rest of the body. They are easier to treat but, if left untreated, undetected, or if they are detected late, they can lead to serious health problems.

Among the bacterial infections frequently met in people living with HIV/AIDS are gingivitis, also called HIV-gingivitis or linear gingival erythema (LGE), and periodontal disease, also called HIV-pertiodontitis or necrotizing ulcerative periodontitis (NUP).

Gingivitis is a chronic inflammation of the gums and it can happen to anybody. Symptoms include bad breath and bleeding. In HIV/AIDS patients, gingivitis is more severe and appears as red band-like lesions along the gumline (where teeth meet the gum). If left untreated, LGE can lead to HIV-periodontitis (NUP), which is an extremely serious condition. NUP attacks the gums, teeth and surrounding bone structure. It can cause tooth loss, bleeding and severe pain. Treatment includes antibiotics, surgical procedures and local debridement (getting rid of dead tissue).

Abnormal tissue growths, or neoplastic lesions, can be benign or cancerous. If cancerous, in the case of HIV patients, they can be manifestations of HIV-related cancers like Kaposi's sarcoma or lymphoma.

Kaposi's sarcoma (KS) is a cancer that affects a patient's skin and/or organs. It appears as purple lesions on the skin. In the mouth, KS can appear as patches or swellings on the gums, tongue, on the roof of the mouth or at the back of the mouth. KS is usually not painful but it can become painful when it interferes with other infections. When painful, oral KS lesions can affect chewing and talking, and also increase the risk of wasting associated with HIV/AIDS or affect treatment, because some medications have to be taken with food. KS usually goes away when the immune system recovers due, for example, to a HAART regimen that works for the patient. KS can be treated locally, using local administered chemotherapy or surgically removing the lesion, or in the entire body, using intravenous chemotherapy.

Lymphoma is more rare than KS and more serious. Lymphoma appears as a small lump in the mouth or near the tonsils. Only a biopsy can determine if a lesion is indeed lymphoma. Treatment includes chemotherapy.

When it comes to dental care, the first question that may occur to HIV/AIDS patients is the disclosure issue. Patients are advised to find a dentist they can trust, be that through referrals or through an AIDS Service Organization (ASO) they work with. It's always best to find a dentist that has experience working with HIV/AIDS patients and knows to look for oral signs of HIV-related illnesses, in order to monitor the progression of the disease and possibly prevent certain oral conditions from occurring. In order to do that, though, dentists have to first be aware of their patients' HIV status. Also, while living with HIV commands certain rules when it comes to dental care, the virus should not exclude patients from dental work or dental maintenance. Quite the contrary.

Tuesday, January 6, 2015

How to Make Product Photography More Interesting (if you are not into it)

"Fancy" is not what comes to mind when describing product photography, but product photography can become fancy, and help pay the bills, too, if done correctly, and also if done with passion. Problem is, not many are passionate about product photography. After all, who would choose spending the day stuck in a room (studio) with a bunch of products (small electronics, jewelry, toys, etc) rather than photographing fabulous models?

I seldom shoot products, but I found that when having to do so, it does help to connect the product I'm about to photograph to something I'm passionate about. If that's not possible, try to find something--it can be the product itself or the light in which it's photograph--that may make it interesting.

For example, over one year or so ago I attended the (re)Presenting AIDS event taking place in Manhattan, and covered it for A&U Magazine--America's AIDS Magazine. At the event, I picked up these AIDS ON GOING GOING ON cloth bags. Once at home, I photographed the bags hanging on my door, to submit, together with the article and other photos taken at the event. (and, yes, I did use scotch tape to get the bags to stay in place on the door, as shown in the picture below)

AIDS ON GOING GOING ON bags photographed by Alina Oswald originally for A&U Magazine.

ACT UP bracelets at Rise Up to HIV NYC event. Photo by Alina Oswald.

For images similar to the above image, especially when shooting in a white room with white doors, either bounce the flash or put it on a stand and attach an umbrella, use a reflector for fill. In the above image there was a window facing the door, and also white walls on each side of the door.

A few months ago I stopped by Washington Square Park to check out the Rise Up to HIV event. See the table full of bracelets below, photographed with my iPhone. (I tried to hold my iPhone as parallel to the table as possible, horizontal, so to speak). For a cleaner look, I could have clone out the white threads in post.

I also bought an ACT UP bracelet for myself.

This past spring, I had the unique opportunity to become part of a collective, later on called the Undetectable Flash Collective. To keep this short (but I may write about it at a later time), I still have to pinch myself, to remind myself that it's true. Words cannot express the honor and pride, and also...humbleness, too, of being part of something like this.

Read more about the Undetectable Collective in an article published in A&U Magazine. Also follow the collective on Tumblr, too.

Here are a few images I took of the Undetectable cards. I rotated the image, for an easier read.

The Undetectable Flash Collective cards, photo by Alina Oswald.

Then, of course, there are the holiday cards, e-cards, I should say. This past year, I wanted to design an e-card that would also bring HIV/AIDS to the minds of those who do connect the dots. And while it doesn't spell it [HIV/AIDS] out, red is the color of the AIDS Ribbon. So, I decided to use red in the image, too.

Thursday, November 13, 2014

Yesterday was not really my day. It was that kind of let-me-be, don't-bother-me type of day. No productivity. No creativity. I felt like I was coming down with a cold, and I had a migraine. (yes, migraines seem to visit me way too often, and as far as I can tell, they don't get easier, shorter or less frequent with age, but anyway....)

Closeup view of the dangling scaffold at One World Trade Center in Lower Manhattan, as seen from Jersey City waterfront. Photo by Alina Oswald. All Rights Reserved.

So, I was trying to print out a photograph for Postcards From the Edge, the Visual AIDS annual fundraising event and art show. The printer didn't want to print right. It turned out that, indeed, I didn't
have enough ink in one of the many cartridges. Hence, no printer head cleaning, and no nice printing either.

Dangling scaffold at One World Trade Center in Lower Manhattan, as seen
from Jersey City waterfront. Photo by Alina Oswald. All Rights Reserved.

I had CNN Go running on my computer, in the background, to keep me company. They kept talking about the comet and landing on the comet, and I was rolling my eyes because they were kinda mispronouncing Darmstadt. For those interested, Darmstadt is a German town, about half-hour away from Frankfurt.

iPhone video at Lower Manhattan and surroundings, as seen from Jersey City waterfront. iPhone video by Alina Oswald.

So...all this was going on when I heard something about something happening at the Freedom Tower sight. I switched my attention to CNN Go to see what they were talking about, and I found myself staring at the picture of the dangling scaffold. My first impulse was to leave everything and go check it out for myself, if anything possible, but I couldn't leave the printer as it was, and I wasn't sure if it was even worth it inquiring any further. What were the chances that I could actually see the scaffold from the Jersey side?

So I decided to wait a few minutes, and finish printing. When the printout still didn't come out right--I think I shook the last drop of ink out of that cartridge, so now I absolutely have to order a new one--I decided to grab the camera and go.

And I did. I grabbed my small camera with the kit lens (it's much lighter than the telephoto one I usually carry around), and took off.

When I finally made it in front of the Hyatt hotel, I could actually see it, the scaffold. The way it looked, from where I was standing...it seemed as if it was hanging straight down, not at an angle, as I'd seen online. The dangling scaffold, pointing down, reminded me of that photograph capturing a guy in free fall, escaping the burning towers. Or maybe the worst of thoughts take over one's mind

It was a windy, partly cloudy day. The sun would peek out from behind the clouds, offering spectacular reflections on the brand new World Trade Center tower. Helicopters were hovering over the area, one closer to the tower, the others further south over the tip of the Manhattan Island. And then the helicopters simply disappeared, flew away, leaving behind a blue, quiet sky.

Although I couldn't see any movement from where I was standing, I told myself that it must have been over. And it must have ended in a good way. While on the waterfront, connection was horrible. I tried several times to tweet and post images online, to no avail. I waited a bit longer, but everybody seemed to have forgotten about the dangling scaffold.

On my way home, I could finally read on Twitter that the rescue operation had been a success. That was good news.

About Alina Oswald

Alina Oswald is a writer, photographer, and author of JOURNEYS THROUGH DARKNESS: A BIOGRAPHY of AIDS. She has documented the AIDS pandemic and the LGBT community, and also covered health/medical, and nature and the environment. Contact her at www.alinaoswald.com.